Risk factors for communicable disease outbreaks in complex humanitarian emergencies
Citation: Hammer CC, Brainard J, Hunter PR. Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: a qualitative systematic review. BMJ Global Health. 2018;3(4):e000647.
Language: Abstract and full text only available in EN.
Free to view: Yes.
Funding sources: National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response at King’s College London (UK) in partnership with Public Health England and in collaboration with the University of East Anglia, Norwich Medical School.
What is this? The preparedness and control of communicable disease outbreaks in complex humanitarian emergencies is a considerable challenge. Identifying risk factors for the rapid spread of these outbreaks will help to address them.
In this systematic review, the authors aimed to identify risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies. They did not restrict their searches by language of publication but limited their searches to literature published after 1993 and did the search in May 2017. They included 26 studies in their thematic synthesis, which were conducted in Afghanistan (4 studies), Democratic Republic of Congo (1), East Timor (1), Horn of Africa (1), Liberia (1), Rwanda (1), Somalia (1), South Sudan (2), and other non-specified settings (14).
What was found: Twelve risk factor clusters for communicable disease outbreaks in complex humanitarian emergencies were identified: poor water, sanitation and hygiene (WASH) conditions; overcrowding; mass population displacement; nutrition (malnutrition, food shortages, food contamination); poor living conditions, especially exposure to indoor air pollution; insecurity; lack inadequacy of infrastructure; poor humanitarian response; environment (weather, vector habitats, increased animal contact, endemic diseases); break down of public health services; and increased HIV-transmission. These risk factors interact with each other, forming complex risk cascades.
Mass population displacement and insecurity are key drivers of risk factors for communicable diseases outbreaks.
Implications: The authors of the review concluded that a rapid and thorough needs assessment should be undertaken to identify and address issues in a complex emergency. They emphasized that more extensive research is needed on structural and operational barriers, and that this should be conducted as collaborations between academics and practitioners.
Other considerations: The authors of the review discussed their findings in the context of place of residence, gender and social capital.
This summary was prepared by Yasmeen Saeed, checked by Ana Pizarro and Cristián Mansilla, and finalized by Mike Clarke.